Anesthetic technique for inferior alveolar nerve block: a new approach

Abstract

BackgroundEffective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 1329% of cases.ObjectiveObjective: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve.Materials and MethodsA total of 193 mandibles (146 with permanent dentition and 47 with primary dentition) from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side), and the second following the oclusal plane (left side), a line can be achieved whose projection coincides with the left mandibular foramen.ResultsThe obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar.ConclusionThis method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry.

Morphological evaluation of the mandibular lingula using cone-beam computed tomography

“…There are some anaesthetic protocols which proclaim the utilisation of long needles for the inferior mandibular nerve block. Use of appropriate length of the anaesthetic needle is important to avoid technical failure, needle fracture and perforation of the parotid gland according to the localisation of the lingula [20]. Sheonoy et al [23] found the distance between anterior border and mandibular foremen 16 mm.…”

Comparison of two approaches to performing an inferior alveolar nerve block in the horse

“…The mandibular foramen block, or inferior alveolar nerve block, is undertaken in human dentistry via an intraoral approach, with the traditional Halstead technique being the most common, 3 which reportedly achieves anaesthesia of the inferior alveolar nerve before it enters the mandibular canal for between 71% and 87% of cases 4 . Because of the anatomic differences between horses and humans, this approach would not be easy in the standing sedated horse.…”

“…The lingual branch of the trigeminal nerve, which provides motor and sensory innervation of the tongue, branches from the mandibular nerve before it progresses rostroventrally to enter the mandibular foramen as the purely sensory inferior alveolar nerve, which innervates the lower dental arcade. 2 The mandibular foramen block, or inferior alveolar nerve block, is undertaken in human dentistry via an intraoral approach, with the traditional Halstead technique being the most common, 3 which reportedly achieves anaesthesia of the inferior alveolar nerve before it enters the mandibular canal for between 71% and 87% of cases. 4 Because of the anatomic differences between horses and humans, this approach would not be easy in the standing sedated horse.…”

A basic review on the inferior alveolar nerve block techniques

“…[12021] The most important clinical landmarks used in the location of the inferior alveolar nerve block are the coronoid notch and the pterygomandibular raphe. The preferred site of needle insertion lies between these two landmarks and the point of insertion is determined by simple measurements.…”

“…The advantages of this technique include a reduction in pain and risk of traumatizing the nerve. The authors of this technique claim that it reduces the risk of systemic complications although there were positive aspirations in some cases (5%), a fact which means that the occurrence of systemic complications is not ruled out by the use of this technique.The new approach of Palti et al ., 2011 for inferior alveolar nerve block[20] This technique aims to identify some easy to find landmarks to locate the mandibular foramen and involves identification of the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of primary second molar or permanent first molar. Two wires are used in this technique, one passing through the mesiobuccal groove and midpoint of the mesial slope in one side of the mandible, while the other is passed over the occlusal plane on the opposite side; the intersection of the two wires indicates the location of the mandibular foramen.…”